living the questions

Bye, April. On the (almost) eve of the fifth month of this rapidly disappearing year, I want to share a quote. The past month has been marked by my struggles to come to terms with some aspects of my leaving in two months. I won't go into too much detail here, but suffice it to say that, like most struggles in my life, I find the answers I am seeking among the pages of my slim, hardbound copy of Letters to a Young Poet, by German poet Rainer Maria Rilke. Perhaps my favorite quote from this volume is the one also most applicable to this month's quandaries, and for all those who aren't familiar with Letters to a Young Poet, here it is:

"Have patience with everything that remains unsolved in your heart. Try to love the questions themselves, like locked rooms and like books written in a foreign language. Do not now look for the answers. They cannot now be given to you because you could not live them. It is a question of experiencing everything. At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer, some distant day."

Aside from learning to love the questions as I live them, I am also trying to chill out. The data collection portion of my research is winding down, and I have already begun the process of analysis (right now, qualitative coding) - yet another unfamiliar research task that I am teaching myself as I go.

I currently have a friend visiting - someone I haven't seen since we were last together in Peru - and a handful of other friends will be dropping by before my time on the island is up. So I'm also trying to relax a bit more and make a deliberate attempt to enjoy myself, as hard as some of the aforementioned questions are. Even recent weekend trips to the gorgeous beaches of the northern Samana peninsula, Cabarete, and to 27 Charcos, a charming set of 27 waterfalls cascading down a mountain up which you can hike before jumping/sliding your way down, were mediocre for me because of these struggles. But I am determined to return to the U.S. on June 24 relaxed, calm, and peaceful - ready for medical school!

God, part 2

While the Evangelist Jesus talk makes me feel uncomfortable, today I was reminded of the important role of religion in many social movements. I went to a conference/talk related to TB in which a pastor gave a galvanizing sermon about the grassroots movement he wants to start to eradicate TB in the DR. Although I felt frustrated by the social pressure to bow my head in prayer, I was inspired by the pastor's words and gave him my business card, telling him that if there are going to be any health-related grassroots social justice movements in the next few months to count me in. It also gave me some ideas about how to respond to the MDR-TB man's challenge (see my previous entry). It's one thing to write a report, even to get a paper published. Those are nice goals, but I want to change something. And I now have some ideas about how to do so.

Later, I began to reflect on the legacy of Gustavo Gutiérrez and other revolutionaries whose motivation to act springs from a religious base. Much of the community organizing for social justice in the U.S. began (and continues to begin) in religious contexts - from Martin Luther King's pulpit leadership in the Civil Rights Movement to Barack Obama's career as an organizer beginning in the church basements of southside Chicago. If you aren't familiar with Gutiérrez's framework of liberation theology, check this out:

"But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order."

— Gustavo Gutiérrez

Sounds like revolution to me! So I am hope that I am not misunderstood in my lamentation about the hyper-Christianity of some Dominicans I've encountered. I don't wish to imply that there is something inherently wrong with being religious; I just balk at proselytizing and attempts at conversion of others. I think that when religions of the world can learn to respect each others' inherent similarities and the moral mandate of justice-seeking that nearly all possess, faith will be a powerful tool for social change. But only if such a movement is broad enough to include all faiths as well as secular civil society. True activism finds a way to promote the inclusion of all interested parties, since the point of activism, after all, is to rearrange the social orders that result in marginalization, exclusion, and other injustices.

timeline

So I’ve bought my return ticket. In just over two months (June 24, to be exact), I’ll be heading home. And I’m about ready. I’m coming to terms with leaving the things that I love here, and as for everything else…well, I’m not so torn up about leaving the things I don’t love.

For example, Dominican elections are in less than a month, which means that the entire country is becoming increasingly filled with apparent flashmobs of people cheering for one politician or another, backed up by huge posters that all have the same catchphrases below their candidates’ beaming faces (“change…now!” – “friendly and capable” – “honest and trustworthy” – “the people’s Senator!”). Of course there is ridiculously loud merengue, some of it made-up political songs and some of it incongruous Omega tunes that are meant more for hip-to-hip grinding in a Presidente-filled colmado than for a political rally. A lot of people tell me that these mobs of “supporters” are just random people that candidates pay to stand around waving flags and acting like they are very excited. Given the general attitude of most Dominicans about politics, this isn’t hard to believe. The vast majority of people are skeptical of politicians – not difficult to understand when higher-ups in the government are known for corruption, from money laundering to narco-trafficking, and in decades of elections promising monumental change the government somehow still cannot manage to guarantee electricity and access to clean water for everyone. Oh, and in case that wasn’t clear, Dominican elections count as something I don’t love because I can’t stand social inequality or excruciating noise.

Here is another anecdote that I think epitomizes why life in this country has lost some of its charm: the other day a washing machine crashed into the guagua (public transportation in the form of a beat-up bus that violates all environmental and safety standards for probably every other country in the world) I was on. No, seriously - I was sitting up front and I saw the whole thing happen. We were driving through the barrios on my way to the clinic when, as if in slow motion, a washing machine came hurtling down the road toward us. It skidded into the left side of the guagua, and everyone who hadn't seen what it was swore we'd hit one of the ubiquitous motorcyclists. The driver got out and, cursing, dislodged the washing machine from the bus fender and deposited it on the side of the road. It's difficult to explain why my next thought was, only in the Dominican Republic. I hope it's not hard to understand why I'm a bit homesick for a country where washing machines do not routinely crash into vehicles in the middle of the road.

One of the most important questions about leaving, however, is what I’ll be leaving behind, work-wise. One of the TB patients today (the man with MDR-TB about whom I wrote a few entries ago) asked me what the outcome of my research would be. “What are you actually going to do if we tell you that we aren’t treated well? That we have problems here?” I felt ridiculous saying, “well, the hope is that what I learn will help to inform future TB programs, but I can’t promise concrete changes in the way things are run at this clinic.”

What am I actually going to do? One of the good things about my timeline is that I feel only a pressure to get all the data collected, but not necessarily to analyze it. That next research step is something I can always do from the U.S. While this might be completely delusional given the fact that I am going to be a first-year medical student as of this August, it makes me feel better about June’s approach. It also gives me the freedom to do a few other things I want to make sure I get done before I leave – things that can’t be done from home. I have at least a few friends coming to visit me before my time here is up, so I plan to squeeze in the last bit of traveling I want to accomplish when they arrive. And of course there is spending time with the people I won’t be seeing regularly once I move to Tennessee.

Research-wise, I have much to accomplish and the work will not end with the end of my grant. In case you weren’t thoroughly convinced of the urgency of it by the last few entries, here’s a recent article in one of the main Dominican newspapers. If you don’t read Spanish, allow me to summarize: According to the Pan-American Health Organization, the DR is the country with the third-highest rate of TB incidence in the Americas. Factors responsible for the high incidence of TB include concurrent disease incidence such as HIV/AIDS, diabetes, and cancers, malnutrition and hunger, socio-economic inequality, and poor living conditions – all of which are prevalent in the DR.

So thanks for the challenge, MDR-TB guy. Let’s hope something useful comes out of all this.